Healthcare Provider Details

I. General information

NPI: 1275712184
Provider Name (Legal Business Name): AMANDA MICHELLE HOUSH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA M MILLER DC

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 COMMONS CIR A
YUKON OK
73099
US

IV. Provider business mailing address

2800 SIENA CIR # A
YUKON OK
73099-3564
US

V. Phone/Fax

Practice location:
  • Phone: 405-577-6268
  • Fax: 405-577-6371
Mailing address:
  • Phone: 405-206-9312
  • Fax: 405-577-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3850
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: